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JRCERT Update

Stephenson

Table 2
Treatment for Severe Reactions to Contrast Media 3
Severe Reactions Methods
Anaphylactic response with dyspnea and hypoxia O2, oral or IV diphenhydramine, IV or IM epinephrine
Upper airway compromise, laryngeal edema, stridor, wheezing O2, inhaled albuterol, IV or IM epinephrine
Anaphylactic shock O2, IV or IM epinephrine
Hypertensive emergency IV labetalol, sublingual nitroglycerin, IV furosemide
Seizure Lorazepam
Cardiac arrhythmia Advanced cardiac life support protocol
Bradycardia and hypotension Reverse Trendelenburg position, IV atropine, carotid massage
Contrast extravasation with persistent neurovascular changes Frequent neurovascular checks, consult plastic surgery, send to the
emergency department

Communication and Documentation providers are unaccustomed to managing them. Some
Because the health care team works together to man- providers will be reticent to identify and treat a patient
age patients’ adverse reactions to contrast administration, experiencing these types of reactions. However, a reluc-
communication is critical, especially when the reactions tance to initiate the management response could delay
are severe and life-threatening. To ensure that steps are effective and decisive care to the patient. Providers
communicated and executed appropriately, the individu- should participate in periodic training to ensure they
al leading the management team (usually the responsible are knowledgeable and psychologically ready to address
provider) must provide clear and direct instructions to these conditions as they arise. 3,19
team members as well as assign management tasks to
specific team members. The leader should employ direct Conclusion
eye contact and use team members’ names when possible Despite the development of increasingly safer con-
to clarify the intended recipient of instructions. Further, trast media, members of the imaging team must be
the recipient should repeat the instructions to confirm able to identify and manage acute adverse reactions to
understanding. Once the instructions have been carried these substances. In addition, educators must be able
out, the performing team member should verbalize task to prepare students for this aspect of their professional
completion. Each management step also must be docu- discipline. Optimally, each member of the reaction
mented in the patient’s medical record. Accordingly, an management team will:
important role in the management team is the scribe, ƒ have a general familiarity with the appearance of
who records each management step taken and the time each type of adverse reaction
the steps were performed. Documentation also should ƒ demonstrate proficiency in initiating the early
include the patient’s response or lack of response to treat- nonspecific management steps
ment measures, the outcome, and any transfer of care. ƒ know the location of and how to use management
tools and equipment
Situational Awareness and Training ƒ possess a solid understanding of the core
Among the factors that pose challenges to provid- philosophical principles and best practices of
ers when managing adverse reactions to contrast management
administration, psychological factors can be the most Including contrast administration, reactions, and man-
challenging. These reactions, especially the most severe agement in curriculum is critical for the education of
ones, are encountered so infrequently that most care excellent radiologic technologists because doing so will

RADIOLOGIC TECHNOLOGY, July/August 2018, Volume 89, Number 6 605
Reprinted with permission from the American Society of Radiologic Technologists for educational purposes. ©2019. All rights reserved.